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Raymond Iezzi, Sarah R Hatt, David A Leske, Jonathan M Holmes; The Double-edged Sword of Epiretinal Membrane Surgery: Improving Versus Inducing Diplopia. Invest. Ophthalmol. Vis. Sci. 2018;59(9):864.
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To evaluate the effect of epiretinal membrane (ERM) surgery on central-peripheral rivalry (CPR)-type diplopia (aka retinal diplopia or dragged-fovea diplopia, caused by underlying retinal misregistration).
Patients undergoing ERM surgery were prospectively enrolled and completed the standardized diplopia questionnaire (DQ) preop, and were examined 1-yr postop (median 13 months). We separately analyzed: 1) patients with confirmed CPR-type diplopia preop (diplopia “sometimes” or more for distance straight ahead or reading using the DQ, with retinal misregistration [optotype-frame test or simultaneous perception synoptophore slides], where other causes did not fully explain the diplopia); 2) patients with no diplopia preop. For those with CPR-type diplopia preop, diplopia was classified as “improved” if rated “never” for distance straight ahead and reading postop. Non-diplopic patients were classified as “induced” CPR-type diplopia if rated “sometimes” or more for distance straight ahead or reading. The proportion with diplopia versus no diplopia was calculated pre- and post ERM surgery and median logMAR VA compared.
Preop, 8 (29%) of 28 had CPR-type diplopia and 20 (71%) were non-diplopic. Postop, 3 (38%, 95% CI 9% to 76%) of 8 diplopic patients had improved CPR-type diplopia whereas 3 (15%, 95% CI 3% to 38%) of 20 non-diplopic patients had induced CPR-type diplopia. In patients who were diplopic preop (n=8), median VA in the operated eye changed from 0.15 logMAR preop to 0.2 postop, but differed between those who became non-diplopic (0.3 preop to 0.3 postop) and those who remained diplopic (0.1 preop to 0.2 postop). For patients who were non-diplopic preop (n=20), median VA in the operated eye improved from 0.5 preop to 0.2 postop, and improvement was somewhat similar in those who remained non-diplopic (0.6 preop to 0.2 postop) and those with induced CPR-type diplopia (0.5 preop to 0.1 postop).
CPR-type diplopia in the context of ERM is associated with better VA, whether preop or postop. ERM surgery may improve diplopia for some previously diplopic patients, but that improvement may be associated with poorer postop VA. In contrast, ERM surgery may induce CPR-type diplopia in some previously non-diplopic patients, and that new diplopia may be associated with better postop VA.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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